109 - Diversifying QI Approaches to Support Implementation of Suicide Prevention Protocols in Primary Care

Abstract Information: Suicide is a leading but oftentimes preventable cause of death for youth. While many pediatricians care for patients with suicide risk, educational efforts are needed to improve pediatrician assessment and management of suicide risk. This includes development and implementation of clinical pathways for suicide prevention. In response, the American Academy of Pediatrics (AAP) and the American Foundation for Suicide Prevention (AFSP) partnered to develop a quality improvement (QI) training program that builds capacity among pediatric clinicians to integrate use of the clinical strategies described in the Blueprint for Youth Suicide Prevention, utilizing the Project ECHO telementoring model. Data were collected from pediatric clinicians who participated in an 8-month ECHO cohort. Participants chose a program track that incorporated QI or education only. Evidence-based ECHO methodology was followed, including the adherence to regular Plan-Do-Study-Act (PDSA) cycles for QI participants and monthly telementoring sessions for all participants. A mixed-methods evaluation design utilizing concurrent data collection was implemented and included chart review for QI participants and post-session and post-program surveys for all participants. Key informant interview data describe themes related to attrition in the QI track as well as barriers to implementation of suicide prevention protocols. 22 participants (68% pediatrician, 32% white) representing 20 practices (85% primary care, 50% suburban) registered. Of 14 practices enrolled in QI, 1 (7%) completed participation requirements. 92% of post session survey respondents (n=12) agreed their knowledge, commitment, and ability to apply learning into practice increased after participation. Post program survey responses were low (n=1) but indicate increased participant capacity for practice change related to suicide risk screening and assessment. Emergent themes from key informant interviews and meeting notes show attrition in QI due to burnout with quality initiatives, challenges with completing QI requirements, and changes to clinical staff. Low engagement may be related to the program timing. To better meet the needs of pediatric clinicians and in line with an equity-driven evaluation approach, data from this ECHO cohort were used to transform the strategies utilized in the subsequent cohort. Aims for this cohort were redesigned to increase participant engagement and attainability to complete QI participation requirements. Diverse approaches were established to identify drivers of developing and implementing clinical suicide prevention pathways in primary care, including: a 15-minute extension of each ECHO session to incorporate care transformation topics, the addition of interactive components, a reduction in the number of measures and chart reviews for QI participants, the adaption of data collection protocols, and integrating feedback into ECHO session content in real-time. In summary, pediatric clinicians who participated in a QI telementoring program aimed at integrating use of the clinical suicide prevention strategies self-reported increases in knowledge, commitment, and confidence. Despite this, practice and systems level barriers exist that impact a pediatric clinician’s ability to participate in a QI project that involves care transformation. Developing diverse approaches that address these barriers, and being able to adapt evaluation methods in real-time, may be effective strategies to increase participation in QI and improve the quality of comprehensive health care to youth.